Stable Angina

Question 1

What is Angina due to?

Answer 1

Narrowing of the coronary arteries due to atherosclerosis causes reduced blood flow to the myocardium

Question 2

How many classes of angina are there?

Answer 2

Four

Question 3

What is class 1 of Angina?

Answer 3

Only on strenuous or prolonged physical activity

Question 4

What is class 2 of Angina?

Answer 4

slight limitation, with angina only during vigorous physical activity

Question 5

What is class 3 of Angina?

Answer 5

Symptoms with everyday living activities

Question 6

What is class 4 of Angina?

Answer 6

Inability to perform any activity without angina or angina at rest i.e. unstable angina

Question 7

What is the Gold standard for the diagnosis of Angina?

Answer 7

CT Coronary Angiography

Question 8

What is a CT Coronary Angiography?

Answer 8

Injecting contrast and taking CT images timed with the heart beat, highlighting any narrowing.

Question 9

What other investigations should you carry out for Angina?

Answer 9

ECG
Echocardiogram
Exercise stress tests with a ECG

Question 10

What are the 3 aims of treatment?

Answer 10

Immediate symptomatic relief
Long term symptomatic relief
Secondary prevention of cardiovascular disease

Question 11

What is administered for immediate symptomatic relief?

Answer 11

GTN spray

Question 12

What does GTN spray cause?

Answer 12

Vasodilation

Helps relieves the symptoms.

Question 13

How should GTN spray be administered?

Answer 13

Take GTN, then repeat after 5 minutes.

If there is still pain 5 minutes after the repeat dose – call an ambulance.

Question 14

What is given for long term symptomatic relief?

Answer 14

Beta-blockers

Calcium channel blockers (CCB’s)

Question 15

What is given for secondary prevention of cardiovascular disease?

Answer 15

Beta-blockers

Calcium channel blockers (CCB’s)

Question 16

Which and what does of Beta blocker is given?

Answer 16

Bisoprolol

5mg daily

Question 17

Which and what dose of calcium channel blocker is given?

Answer 17

Amlodipine
5mg daily

Question 18

What is the possible surgical management of Angina?

Answer 18

PCI

CABG

Question 19

Which drugs are commonly given for secondary prevention?

Answer 19

Aspirin (i.e. 75mg once daily)
Atorvastatin 80mg once daily
ACE inhibitor

Question 20

What are other possible drugs for angina that are not first line?

Answer 20

Long acting nitrates (e.g. isosorbide mononitrate)
Ivabradine
Nicorandil
Ranolazine

Question 21

If angina is stable, what is it always relieved by?

Answer 21

Rest or GTN

Question 22

When would angina be considered as unstable?

Answer 22

If the symptoms were occurring at rest

Question 23

Where is the site of anginal pain?

Answer 23

Retrosternal

Question 24

What is the character of anginal pain?

Answer 24

Tight band
Pressure
Heaviness

Question 25

Where does anginal pain radiate to?

Answer 25

Jaw Neck Arms

Question 26

What aggravates anginal pain?

Answer 26

Exertion Emotional distress Cold weather Heavy meals

Question 27

What are relieving factors of angina?

Answer 27

Rest GTN

Question 28

How is angina graded?

Answer 28

CCS (canadian cardiovascular scale)

Question 29

What happens to the heart muscle as a result of angina?

Answer 29

Ischaemia occurs when myocardial oxygen demand is greater than supply Atherosclerotic plaques narrow the lumen of the coronary arteries

Question 30

What is stable angina?

Answer 30

When symptoms of angina are always relieved by rest and GTN spray

Question 31

What is unstable angina?

Answer 31

When symptoms come on randomly whilst at rest

Question 32

What is the most common cause of angina?

Answer 32

Atheroma

Question 33

What are non-modifiable RF for angina?

Answer 33

- age - male gender - family history of ischaemic heart disease

Question 34

What is the first line long term treatment for stable angina?

Answer 34

Monotherapy of CCB or BB

Question 35

What are the 2 main side effects of GTN?

Answer 35

Headaches Dizziness

Question 36

If a CCB is being used as montherapy, which drugs should be used?

Answer 36

Verapamil or diltiazem

Question 37

What is the problem with verapamil and diltiazem?

Answer 37

Avoided in heart failure with reduced ejection fraction

Question 38

If using a CCB in combination with a BB, which CCB should be used?

Answer 38

Amlodipine

Question 39

if a patient is on monotherapy and cannot tolerate the addition of a calcium channel blocker or a beta-blocker, which medications can be offered?

Answer 39

Long-acting nitrates (e.g., isosorbide mononitrate) Ivabradine Nicorandil Ranolazine

Question 40

If a patient is taking both a CCB and a BB and still having symptoms, what can be added?

Answer 40

Long-acting nitrates (e.g., isosorbide mononitrate) Ivabradine Nicorandil Ranolazine

Question 41

How long should patients be taking 3 drugs for angina?

Answer 41

Whilst a patient is awaiting assessment for PCI or CABG

Question 42

What interventions can be offered for angina?

Answer 42

PCI CABG

Question 43

What is the problem of prescribing verapamil and a beta blocker together?

Answer 43

Complete heart block